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Abstract

The pathophysiological significance of catecholamine system in hyperaldosteronism remains unknown. Previous evidences showed that patients with primary aldosteronism had elevated plasma and urinary total dopamine. Further, medullary cells, especially in the zona glomerulosa, frequently spread into the subcapsular region, forming large nests of chromaffin cells. Aim of this study was to evaluate the adrenal vein catecholamine and chromogranin A levels as indicator of the source of aldosterone excess in 21 patients with primary aldosteronism who had venous sampling. Subjects and Methods:Twenty-one patients (13 males and 8 females, aged 32-58 yr) referred since 1998 to our center were studied. We studied 13 patients with aldosterone-producing adenoma (APA) and 8 patients with idiopathic hyperaldosteronism (IHA). The presence of the dominantly inherited syndrome glucocorticoid remediable aldosteronism was excluded by either a long-polymerase chain reaction (PCR) test or Southern blot analysis. Results: Adrenal CT and adrenal venous sampling were performed in all 21 patients. Both adrenal veins were catheterized successfully in all patients. Findings on adrenal CT were normal in 8 patients, unilateral adenoma in 13 patients. All the patients showed higher levels of catecholamines than the cortisol levels on the side of adenoma and of hyperplasia, (p<0.01). The difference in levels of catecholamines between adenoma and hyperplasia were not significant. Further, the chromogranin levels found in adrenal veins were in the range of normalcy. Conclusion: Firstly, in all patients we found normal levels of chromogranin A in adrenal veins that excluded the presence of pheochromocytoma and confirmed the functional secretion of catecholamines. Hence, by taking into account the previous evidences of some clinical case of Conn adenomas or primary aldosteronism associated with catecholamine-secreting pheochromocytomas, our findings may suggest the possibility of paracrine control of the human adrenal cortex by chromaffin tissue. Further, adrenal catecholamines sampling may enable preoperative localization of adenoma with more accuracy, especially when the tumour is small or the result of CT and scintigraphy is not consistent. In conclusion, the results of our study indicate that catecholamine together with aldosterone levels in adrenal vein may be a crucial and useful diagnostic tool as indicator of aldosterone excess source in patients with unilateral adenoma or bilateral hyperplasia.

primary aldosteronism, chromogranin A, had venous sampling
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© American Journal of Hypertension, Ltd. 2001
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